Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: The efficacy of virtual reality (VR)-based intervention for improving cognition in patients with the chronic stage of stroke is controversial. The aims of this meta-analysis were to evaluate the effect of VR-based training combined with traditional rehabilitation on cognition, motor function, mood, and activities of daily living (ADL) after chronic stroke.Methods: The search was performed in the Cochrane Library (CENTRAL), EBSCO, EMBASE, Medline (OVID), Web of Science databases, PubMed, CINAHL Ovid, and Scopus from inception to May 31, 2021. All included studies were randomized controlled trials (RCTs) examining VR-based intervention combined with traditional rehabilitation for chronic stroke. The main outcomes of this study were cognition, including overall cognition (combined with all cognitive measurement results), global cognition (measured by the Montreal Cognitive Assessment, MoCA, and/or Mini-Mental State Examination, MMSE), and attention/execution. The additional outcomes were motor function, mood, and ADL. Subgroup analyses were conducted to verify the potential factors for heterogeneity.Results: Six RCTs including 209 participants were included for systematic review, and five studies of 177 participants were included in meta-analyses. Main outcome analyses showed large and significant effect size (ES) of VR-based training on overall cognition (g = 0.642; 95% CI = 0.134–1.149; and P = 0.013) and attention/execution (g = 0.695; 95% CI = 0.052–1.339; and P = 0.034). Non-significant result was found for VR-based intervention on global cognition (g = 0.553; 95% CI = −0.273–1.379; and P = 0.189). Additional outcome analyses showed no superiority of VR-based intervention over traditional rehabilitation on motor function and ADL. The ES of VR-based intervention on mood (g = 1.421; 95% CI = 0.448–2.393; and P = 0.004) was large and significant. In the subgroup analysis, large effects for higher daily intensity, higher weekly frequency, or greater dose of VR intervention were found.Conclusion: Our findings indicate that VR-based intervention combined with traditional rehabilitation showed better outcomes for overall cognition, attention/execution, and depressive mood in individuals with chronic stroke. However, VR-based training combined with traditional rehabilitation showed a non-significant effect for global cognition, motor function, and ADL in individuals with chronic stroke.

Altered effective connectivity in the emotional network induced by immersive virtual reality rehabilitation for post-stroke depression

“…In the past few years, many preliminary studies have shown that VR-based training combined with traditional rehabilitation was more effective for improving depressive symptoms in stroke survivors than traditional rehabilitation ( Gao et al, 2021 ). However, in most previous studies, the mood symptoms were not the primary therapeutic target, and the studied included patients with chronic stroke.…”

Emerging Limb Rehabilitation Therapy After Post-stroke Motor Recovery

“…Immersive real feelings can be obtained through visual, auditory, or tactile real-time perception and operation of various objects inside the virtual world ( Chang et al, 2020 ; Xiong et al, 2021 ). Due to high safety, high interest, timely evaluation, and feedback, VR has been gradually applied in rehabilitation treatment after stroke ( Gao et al, 2021 ; Hao et al, 2021 ; Xiong et al, 2021 ).…”

A Systematic Review of Virtual Reality-Based Education Research Using Latent Dirichlet Allocation: Focus on Topic Modeling Technique

“…ese studies reviewed the previous articles to answer specific research questions for understanding important keywords or topics of the field. Some review papers focused on the trends of virtual reality-based education research related to specific fields as shown in Table 1, such as Earth science engineering education [7], medical education [8,19], STEM education [20], math education [21], computer science education [22], higher education [23][24][25], heritage education [26], rehabilitation management of breast cancer survivors [27], virtual reality-based training for daily living in patients with chronic stroke [28], PSTD treatments [29], foreign language learning gamification using virtual reality [30,31], K-12 and higher education [15,17], surgical training [32], industrial skills training [31], virtual reality cognitive training in individuals with mild cognitive impairment [16,18], science education [33,34], sensorimotor learning [35], dental education [36], virtual reality-based emotional response and symptom provocation in patients with OCD (obsessive compulsive disorder) [37], nursing education [38,39], virtual reality therapy for social anxiety disorder [40], evacuation training [41], virtual reality-assisted neuromuscular therapy [42], home-based virtual reality rehabilitation for individuals with Parkinson disease [43], virtual realitybased physiology and anatomy learning [44], social work education [45], and marketing higher education …”